POS0271 CLINICAL SYMPTOMS AT GIANT CELL ARTERITIS DIAGNOSIS AS PREDICTORS OF PERMANENT VISUAL LOSS.
Authors: J. Mestre-Torres, B. Escalante, E. Fonseca, A. Martinez-Zapico, M. Monteagudo, M. Abdilla, M. Perez Conesa, B. Gracia Tello, S. Prieto-González, G. Fraile, R. Solans-Laqué
Journal: Annals of the Rheumatic Diseases (2022)

Background Giant cell arteritis (GCA) is the most prevalent vasculitis in the elder. Nearly 20% of patients experience transient or permanent visual loss (PVL). It has been reported that erythrocyte sedimentation rate (ESR), haemoglobin (Hb), constitutional syndrome (CS) and fever are prognostic factors that predict PVL but models have shown poor diagnostic performance. Objectives To evaluate if clinical signs, symptoms and blood tests can predict PVL at GCA diagnosis. Methods We retrospectively included patients from the Spanish Vasculitis Registry (REVAS) from 2005 to 2009. Clinical and blood tests data were obtained from medical records. We randomly split the cohort using shrinkage function to create a derivation and a validation cohort. In the derivation set we compared data and we built a multivariable logistic regression model to predict PVL. Internal validity was evaluated with 1000 bootstrap. External validity was evaluated using the validation set of data. Performance of the model was determined using the area under the curve (AUC) with 95% confidence interval. Calculations were done using StataBE 17.0. Results We included 620 patients (derivation cohort: 397 patients). Clinical signs, symptoms and blood tests results according to the presence or absence of PVL (Table 1). Mean age at diagnosis was 76.3 years and PVL was present in 86 (21.7%) patients. Significant predictors at baseline were age (p=0.000), hypertension (p=0.04), fever (p=0.001), jaw claudication (0.000), transient visual loss (TVL, p=0.000) and decreased temporal artery (TA) pulse (p=0.004). Multivariable logistic regression showed that age older than 75 years (OR 2.7, p=0.000), jaw claudication (OR, 2.75; p=0.000) and TVL (OR 7.2, p=0.000) were risk factors for PVL. CS was the only protective factor (OR 0.57, p=0.017). Hypertension (OR 1.4, IC95%: 0.88 – 2.3) and diabetes (OR 1.63, IC95%: 0.94 – 2.8) were not statistically significant. Our model showed an AUC 0.8 (IC 95%: 0.75 – 0.84). A 1000 bootstrap analysis showed good internal validity (AUC 0.79, IC95%: 0.74 – 0.83). Validation cohort comprised 223 patients and the AUC of the model in this dataset showed an AUC 0.81. We compared our model to previously published models and we found that our model had a higher AUC (AUC 0.8, IC 95%: 0.75-0.84 vs. AUC 0.65, IC95%: 0.6 – 0.7; p &lt; 0.0001). Table 1. Baseline date according to the presence or absence of permanent visual loss. Permanent Visual Loss No Permanent Visual Loss Variable Mean/Proportion SD Mean/Proportion SD Significance Female 69.8% 72.0% 0.68 Age &gt;75 y.o. 72.1% 53.4% 0.000 Hypertension 64.3% 51.6% 0.04 Diabetes 25.9% 16.9% 0.06 Fever 18.6% 36.8% 0.001 Constitutional syndrome 42.4% 53.2% 0.075 Polymyalgia 40.7% 39.7% 0.87 Headache 79.1% 79.2% 0.987 Jaw claudication 68.2% 39.7% 0.000 Tenderness of the TA 38.6% 31.4% 0.22 Transient visual loss 39.0% 10.5% 0.000 Stroke 3.5% 3.9% 0.86 Transient ischaemic attack 0.0% 4.2% 0.053 Decreased TA pulse 66.7% 48.0% 0.004 TA enlargement 55.1% 50.9% 0.51 Haemoglobin 11.1 1.2 11.4 1.4 0.37 Erythrocyte sedimentation rate 95.0 26.2 96.4 26.8 0.67 C Reactive protein 9.7 6.2 10.4 8.6 0.8 SD: Standard deviation. TA: Temporal artery. Conclusion Age &gt; 75 years, jaw claudication and TVL can predict PVL, being the CS a protective factor for this complication. Blood test data are not good PVL predictive factors. References [1]Nesher G. J Autoimm. 2014;48-49:73-75. [2]Cid MC et al. Arthritis Rheum. 1998;41:26-32. Acknowledgements on behalf of the Spanish Resgistry of Systemic Vascuitis (REVAS) Disclosure of Interests None declared